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A floating mural thrombus in the ascending aorta can cause multiorgan infarction
  1. Risa Hirata,
  2. Masaki Tago,
  3. Tomotaro Nakashima and
  4. Yuka Hirakawa
  1. Department of General Medicine, Saga University Hospital, Saga, Japan
  1. Correspondence to Dr Masaki Tago; tagomas{at}


A man in his 50s with sudden-onset left-sided subcostal pain was diagnosed with splenic infarction by thoracoabdominal CT with contrast enhancement, which also revealed a mural thrombus in the thoracoabdominal aorta, raising the possibility of aortic dissection. The electrocardiographic findings were normal and transthoracic echocardiography did not detect thrombus in the heart. Antihypertensive medication was administered on admission, and anticoagulation therapy was started after he developed left renal infarction and occlusion of the superior mesenteric artery. Nevertheless, he subsequently sustained an acute cerebral infarction. Transoesophageal echocardiography revealed an abnormal floating structure in the ascending aorta, which was surgically removed and finally diagnosed as an organising thrombus. Although most of the causes of multiorgan infarction are cardiogenic, floating mural thrombus can also be a cause. Anticoagulation therapy may be necessary for patients with recurring severe embolisms even when aortic dissection has not been completely ruled out.

  • Cardiothoracic surgery
  • General practice / family medicine
  • Stroke

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  • Contributors RH was involved in concept, literature search, drafting. MT was involved in concept, literature search, drafting and revision of article. TN was involved in literature search and drafting. YH was involved in clinical care of the patient, literature search and revision of article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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